Is it a fantasy? Is it a dream? Is it a story of a search for missing characteristics? Is it possible or is it even Kansas?

In preparation for my recent essay I came across the Really Learning Website and a “subjective think piece” written by Valerie Iles that explores the introduction of management into the NHS over the last twenty years, its relative successes and alternative approaches.

The piece is insightful, thought provoking and challenging. You should read it. It finishes with a paragraph that summarises much of what I have blogged about over the last few months.

“As we challenged our assumptions we might also recognise as fundamentally flawed the notion that any management consultant or policy advice team is better at devising structures and processes for the complex, dynamic interdependent set of systems, that together comprise our national health care, than are the people working within them. It is not Roy Griffiths’ fault that his prescription took the system as a whole in the wrong direction for 20 years, but we must make sure we never again allow one person’s view to prevail. We must find ways of allowing locally relevant solutions to develop and flourish, devised, owned and implemented by local teams of clinicians and managers, held to account only for their outcomes and not for implementing a centrally prescribed set of processes. “